2. * Rabies is a zoonotic disease (a disease that is transmitted from animals to humans) that is caused by a virus. * Nearly half of those bitten by suspect rabid animals are children under 15 years of age. * Rabies is spread to people through close contact with infected saliva via bites or scratches. * Most of the deaths occur in the absence of post- exposure prophylaxis

8. Element of paralysis is dominating, animal is quiet,timid and shy

9. * Rabies is caused by RNA virus of genus Lyssavirus * Family-Rhabdoviridae * Bullet shape * Neurotropic virus * New species discovered in bats

10. Virus is transmitted through saliva of infected animal * Bites * scratch * Licks on injured skin * Licks on mucous membranes * Aerosols (bats in caves) Uncommon routes * Transplants of infected organs * Bite of a rabid human being

11.  Incubation period Varies from few days to years Average 30-90 days Depends upon site, degree and virus load, number of wounds Provides opportunity to start treatment

12. Sr. NoDistrict/AreaNo. of Rabies Patients TreatmentTime between bite and rabies 1.Lahore01Not receivedOne month 2.Lahore01Not received20 days 3.Lahore01Not receivedone and a half month 4.Lahore01Not received3 months 5.Shakargarh (Narowal)01Not receivedone and a half month 6.Chakwal01Not receivedone and a half month 7.Rahim Yar Khan01Not received3 months 8.Khushab01Not receivedone and a half month 9.Shraqpur Sharif01Not received2 months 10.Okara01Not received5 months 11.Muridke01Partly receivedOne month 12.Daska01Not received2 and half month 13Sialkot01Not received3 months 14.Qadirabad01Not receivedOne year 15.Sargodha01Not received3 months 16.DG gkan01Not received2.5 years

15.  Prodromal Phase (2-10 days) Fever, flu like symptoms, headache, anorexia, lethargy, itching or abnormal sensation at the site of wound  Acute Neurological Phase (2-7 days) Anxiety, confusion, aggression or lack of aggression, hyper salivation, muscular spasm, difficulty in swallowing leading to hydrophobia, photophobia, aerophobia

17.  Coma and Death Symptoms progress towards paralysis and coma in both furious and dumb rabies Death usually occurs from respiratory paralysis within days after onset of symptoms

18. * Wounds should be washed/flushed and disinfected immediately. Vaccine and immunoglobulin therapy (when required for the latter) instituted as soon as possible, * If rabies immunoglobulin is not available on first visit its use can be delayed by a maximum of 7 days from date of first vaccine injection, * Initiation of PEP should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected, * Pregnancy and infancy are never contraindications to PEP, * Persons who present for evaluation and rabies post-exposure prophylaxis even months after having been bitten should be dealt with in the same manner as if the contact occurred recently.

19. * Category I :  touching, feeding of animals or licks on intact skin no exposure  therefore no prophylaxis if history reliable * Category II:-  minor scratches or abrasions without bleeding or and nibbling of uncovered skin  use vaccine alone * Category III:  single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva (i.e. licks) and suspect contacts with bats:  use immunoglobulin plus vaccine

20. * Should be immediate * Is essential even if the person presents long after exposure Consists of: * Immediate washing and flushing for 15 minutes with soap and water, or water alone, * disinfection with ethanol (700ml/l) or iodine (tincture or aqueous solution).

21. * The 5 dose intramuscular regime: one dose of the vaccine should be administered on days 0, 3, 7, 14 and 28 in deltoid region or, in small children, into the antero-lateral area of the thigh muscle; * The 2-1-1 regimen may also be used. Two doses are given on day 0 in the deltoid muscle, right and left arm. In addition one dose in the deltoid muscle on day 7 and one on day 21. * Vaccines should not be injected into the gluteal region;

22. * This vaccine is of sufficient potency to allow its safe use in one of the WHO recommended intradermal post-exposure regimens

23. * Immediate Case Notification. * Availability of Anti-Rabies Vaccine. * Special Dog killing campaigns launched by the districts. * Behavioural Change Campaigns. * World Rabies Day- 28 th September.